The Post-operative Outcomes of Spinal Epidural and Subdural Hematoma Patients Without Spinal Fracture

ABSTRACT

OBJECTIVE: Spinal epidural hematoma (SEDH) and spinal subdural hematoma (SSDH) are rare diseases and they may have various causes such as trauma, lumbar puncture, anticoagulant therapy, tumor, blood dyscrasia and vascular malformation. In general, SEDH and SSDH are regarded as surgical emergency. We reviewed our cases with patients with SEDH or SSDH. They were surgically treated or conservatively treated. We examined the relationship between the surgical timing and the neurological outcome. METHODS: Twelve patients (8 cases for SEDH, 4 cases for SSDH) were included in our study. There were seven male and five female patients (mean age 50.2 yrs, ranged from 18 to 87 years). Ten patients were surgically treated (7 cases for SEDH, 3 cases for SSDH) and two patients were conservatively treated (1 case for SEDH, 1 case for SSDH). We checked preoperative Frankel grade, time interval between onset of symptom and operation and post-operative neurologic change of each case. We investigated relationship between surgical timing and neurological outcome and also relationship between pre-operative Frankel grade and post-operative outcome. RESULTS: In seven cases (70%) of operated cases, there were postoperative improvements in clinical symptoms. Two cases had time interval within 6 hours from onset of symptoms to operations and their neurologic deficits were not improved. There were 2 cases with time interval of more than 6 hours and within 12 hours. And there were 6 cases with time interval over 12 hours. Seven of eight cases with time interval over 6 hours were improved after surgical treatments. CONCLUSION: There are various factors which may affect post-operative neurologic prognosis. Surgical timing is generally regarded as one of the most critical factors. However, in our study, preoperative neurologic status of patients functioned as the most important factor in clinical outcomes. We thought that the initial neurologic status of patient, as well as the surgical timing, may predict the prognosis.